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Posttransplant Biliary Complications in Acute-on-Chronic Liver Failure: A Single Center Study
Rachel Davis Bouvette1, Rylee Barber, Zoona Sarwar
1>From the Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Summary
Liver transplant patients with acute-on-chronic liver failure had fewer biliary complications than those without. Comprehensive care is key for managing high-risk transplant patients and preventing complications.
Area of Science:
- Hepatology
- Transplant Surgery
- Gastroenterology
Background:
- Biliary complications are common after liver transplantation, increasing morbidity.
- High-acuity liver transplants are associated with higher rates of biliary complications.
- Acute-on-chronic liver failure (ACLF) presents unique challenges in liver transplant recipients.
Purpose of the Study:
- To assess the incidence of biliary complications in liver transplant recipients with ACLF.
- To compare biliary complication rates between patients with and without ACLF.
- To identify factors associated with biliary complications post-liver transplant.
Main Methods:
- Retrospective analysis of liver transplant recipients from July 2020 to June 2023.
- Comparison of outcomes between patients with and without ACLF.
- Minimum 1-year follow-up post-transplant.
Main Results:
- 18.1% of 116 patients developed biliary complications (7 leaks, 15 strictures).
- Patients with ACLF had a lower complication rate (14.2%) compared to those without (21.7%).
- Longer cold ischemia time, lower MELD scores, higher preoperative cannabis use, and increased readmissions were linked to complications.
Conclusions:
- Biliary complication rates in this ACLF cohort were similar to general liver transplant populations.
- ACLF patients experienced fewer biliary complications, possibly due to multidisciplinary care and adjunct therapies.
- Individualized, comprehensive care is crucial for optimizing outcomes in high-risk liver transplant patients.
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